Rule 120-2-112-.09. Small Business Health Options Program

1. (1) Authorization. Georgia Access is authorized to establish a Small Business Health Options Program, which shall be a small-group health insurance exchange that provides a marketplace for small businesses to purchase health coverage for their employees.
2. (2) Certification. Georgia Access may certify small group plans as QHPs or SADPs for issuers to offer such certified small group plans to Qualifying Business Entities. Georgia Access shall administer a process for agents to become certified to sell Small Business Health Options Program plans. No agent shall sell, solicit, or negotiate any Small Business Health Options Program plan without first being certified by Georgia Access.

3. (3) Eligibility for Participation in Small Business Health Options Program. To qualify for participation in the Small Business Health Options Program a Qualifying Business Entity must satisfy all of the following requirements:

   1. (a) The Qualifying Business Entity shall employ 50 full-time equivalent employees or fewer;
   2. (b) The Qualifying Business Entity shall employe at least one full-time employee other than the owners of a sole proprietorship, partners, shareholders owning more than 2 percent of an S corporation, owners of more than 5 percent of businesses other than an S corporation, family members or dependents, seasonal workers working 120 days or less in a year, Form 1099 workers, or retired enrollees.
   3. (c) The Qualifying Business Entity shall offer coverage to all full-time employees;
   4. (d) The Qualifying Business Entity shall enroll at least 70 percent of eligible FTE employees who are offered insurance and not otherwise covered provided that Georgia Access is authorized to waive the minimum participation requirement from November 15 through December 15 of any year; and
   5. (e) The Qualifying Business shall have a primary place of business or other employee worksite within the state of Georgia and offers coverage to all its full-time employes and has its primary worksite in Georgia or offers coverage to each qualified employee that is serving in and has their primary worksite address in Georgia.

4. (4) Computation of Full-Time Equivalent Employees. For the purposes of this Rule, "full-time equivalent employees" shall be computed by taking the sum of full-time employees and part-time employee equivalents.

   1. (a) All employees that work at least 30 hours per week in any month are counted as one full-time employee.
   2. (b) Part-time employee equivalents are computed by taking the hours worked by all part-time employees in a week and dividing that amount by 30. Part-time employees are employees that work an average of less than 30 hours per week.
   3. (c) Seasonal workers working 120 days or less in a year shall not be counted in the computation.
   4. (d) When computing the number of full-time or part time employees for the purposes of eligibility, a business shall include all full-time employees of a whole group if the business is affiliated with another employer, under common ownership, or is otherwise part of a controlled group and employees under a common group in other states even if such business is enrolled in a separate state's small business health options program.
   5. (e) When computing the number of full time or part-time employees for the purposes of eligibility, a business shall not include owners of a sole proprietorship, partners, shareholders owning more than 2 percent of an S corporation, owners of more than 5 percent of businesses other than an S corporation, family members or dependents, seasonal workers working 120 days or less in a year, Form 1099 workers, or retired enrollees.
5. (5) An employee's exclusion from the computation of the number of full-time equivalent employees shall not disqualify that same employee or employee type from coverage through the Small Business Health Options Program.
6. (6) In conjunction with the Insurance Product Review Division, the Commissioner through Georgia Access shall set Small Business Health Options Program application deadlines and submission requirements. Georgia Access will document the processes and conduct Small Business Health Options Program plan rate reviews in accordance with the Commissioner's authority over the filing of rates. Insurance companies offering Small Business Health Options Program plans shall follow the standards set by Georgia Access, including the allowable timeline for insurance companies applying for rate changes. Insurance companies may request a rate change to their Small Business Health Options Program plan on a quarterly basis through the Georgia Access data change request process, on a timeline established and communicated before each plan year. This timeline and respective deadlines are provided in the Data Change Request Form. Insurance companies may contact Georgia Access SHOP for more information on offering SHOP plans and making a quarterly rate change.
7. (7) Insurance companies participating in the Small Business Health Options Program are required to track progress and report data to verify that the program is meeting requirements established by 45 C.F.R. § 155.721. Insurance companies must submit quarterly reports to Georgia Access SHOP in accordance with the SHOP Issuer Quarterly Reporting Template provided by Georgia Access SHOP to collect quarterly employer and employee enrollment metrics.

Authority: O.C.G.A. §§ 33-1-23; 33-2-9; 50-13-21.

History. Original Rule entitled "Small Business Health Options Program" adopted. F. Sept. 12, 2025; eff. Oct. 2, 2025.